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INTERNATIONAL CENTRE FOR DIARRHOEAL DISEASE RESEARCH, BANGLADESH

Editor: Shereen Rahman Design & Photography: Asem Ansari

A/l published materials cited herearesubject to the copyright regulations of the publisher.Unpublished materials may not be reproduced in any form without written permissionbythe authors and theDirectorlCDDRB.

Photacomposed and Printed by Eastern Commercial Service Limited Dacca, Bangladessh.

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TABLE OF CONTENTS

Board of Trustees 1Staff List 2Introduction 9

Research ProgrammesCommunity Services Research Programme 12 Nutrition Programme Disease Transmission Programme Host Defense Programme Pathogenesis & Therapy Programme

Training, Extension and Communication Training, Extension and Communication Ethical Review Committee Research Review Committee Publications

ICDDR,B Publication Series Original Scientific Published Papers Edited Books and Review Articles Abstracts, Letters and Talks

Organization and ManagementBoard of Trustees Management and Administration Staff Clinic Staff Welfare Association Resources Development Financial Report Glossary

16 20 24 26

Programme 30 37 38

43 44 46 47

55 56 57 58 59 60 63

BOARD OF TRUSTEES

Mr. M.K. Anwar, Secretary, Government of the People's Republic of Bangla- dcush, Dacca

Dr. A.Q.M. Badruddoza Chowdhury. Deputy Leader of the Parliament, Government of the People's Republic of Bangladesh, Dacca

Dr. D.J. Bradley, Professor of Tropical Hygiene and Director, Ross Institute of Tropical Hygiene, London School of Hygiene and Tropical Medicine, London, England

Dr. C.C.J. Carpenter, Professor and Chairman, Department of Medicine, Case Western Reserve University, Cleveland,Ohio, U.S.A.

Dr. Hashim S. AI-Dabbagh, Director General of Preventive Medicine, Ministry of Health, Kingdom of Saudi Arabia

Dr. W.B. Greenough IlI, Director, Inter-national Centre for Diarrhoeal Disease Research, Bangladesh,Dacca, Bangladesh

Dr. J. Holmgren, Director, Department of Bacteriology, Institute of Medical Microbiology, University of Goteborg, Sweden

Dr. G.W. Jones, Development Studies Centre, The Research School of Pacific Studies, The Australian

National University, Canberra, Australia

Professor J. Kostrzewski, Chief, Departmentof Epidemiology, Statelnstitute of Hygiene, Warsaw, Poland

Professor L.J. Mata, Director, Instituto de Investigaciones en Salud (INISA) Universidad de Costa Rica, CiudadUniversitaria, "Rodrigo Facio", San Pedro, Costa Rica

Professor M.A. Matin, Honourable Minister, Government of the People's

Republic of Bangladesh, Dacca, Bangladesh; Chairman, Board of Trustees

Dr. V. Ramalingaswami, Director General, Indian Council of Medical Research, New Delhi, India

Dr. J. Sulianti Saroso, Adviser to Minister of Health, Jakarta, Indonesia

Dr. O.M.Solandt, Chairman, Science Council Committee on Population and Technology, Ottawa, Canada

Dr. M.K. Were, Senior Lecturer, Depart

,'nent of Community Medicine, University of Nairobi, Kenya

Dr. Albert Zahra, Director, Division ofCommunicable Diseases, WHO, Geneva, Switzerland

ANNUAL REPORT 1

STAFF LIST

MANAGEMENT STAFF **Md. Abdullah, BA, LLB, MBIM

K.M.S. Aziz, PhD

M.R. Bashir, BA

*Thomas C. Butler, MD Stanislaus D'Souza, PhD William B. Greenough Ill, BA, MD, FACP Honoria Nielijus, MSBA, CPA M. Mujibur Rahaman, MBBS, MSc, PhD Aziz R. Samadi, MD, DPH Md. Shahabuddin Mark P. Tucker

ANNUAL REPORT 2

Bangladesh Bangladesh

Bangladesh

USA India USA USA Bangladesh Afghanistan Bangladesh USA

General Manager, Administration Associate Director, Training &

Extension Associate Director, Resources

Development Programme Head Programme Head Director Financial Consultant Deputy Director & Programme Head Programme Head Controller, Finance Physical Plant Manager

COMMUNITY SERVICES RESEARCH

*Jalaluddin Akbar. MA

Md. Nurul Alam, MA

K.M.A. Aziz, PhD

*Eleanor Baker, MA

Md. Abd'jllah-Hel Baqui, MBBS

*Stanley Becker, PhD

Saleho Begum, MA

Md. Abbas iUddin Bhuiyan, MA

Jyotsnamoy Chakraborty

A.K.M. Alauddin Chowdhury, ScD Mridul K. Chowdhury, MSc, MPhil A. I.Chowdhury

*Md. Giashuddin, MBBS

Sentu B. Gomes

Md. Emdadul Haque, MA

Md. Emdadul Haque, MBBS

*Md. Mahbub Hossain, MBA * Md. Ataul Huqq. BA,Dip EDP

Shafiqul Islam, MA

A.K.M. Nuru! Islam

Nasrin Jahan, MBBS

*Md. Rezaul Karim, MSc

Md. Khalequzzaman, MBBS

M.M Rahman Khan

M. Khoridnker, MSc, DipEd

David Leon. MA

*Amal Krishna Mitra, MBBS, DIH

Mohd. Moshin

Md. Ibrahim Mollah, MSc

"Abdullah Hel-Mustafa, BSc, [)IpEDP *Chowdhury BA. Mustafa, MSS

Md. Easin Aziz Muttaqi, MSc

Elizabeth Gabrielle Palmade, AB

James Phillips, PhD

*Makhlisur Rahman, MA

Sayeedur Rahman

"F.M. Ziaur Rahman, MSc

* Md. Anisur Rahman, MSc

"Mizanur Rahman, MSc

M.A. Razzaque, MSc

Nikhil Chandra Roy, MSc

Ahmed Saber, MSc, MS (Comp. Sc.)

* Loretta Saldanha A. Mazid Sarder Jatindra Nath Sarker Thomas M. Sarker, MSc Brian Seaton, MA, MSc, DPhil, AIMLS

*M. Shahidullah, MSc, MA

-M.A. Kashem Shaikh, BA

""Md Yunus, MBBS

Susan Zirnicki, MS,MS (IH)

PROGRAMME

Bangladesh Bangladesh Bangladesh USA Bangladesh USA Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh USA Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh. Bangladesh Netherlands USA Bangladesh Bdngladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh India Bangladesh Bangladesh Bangladesh UK Bangladesh Bangladesh Bangladesh USA

Demographer Statistical Officer Anthropologist Research Associate/Programmer Senior Medical Officer (Acting) Demographer Trainee Orogrammer Research Associate Senior Field Research Officer Demographer Data Management Branch Head Statistical Officer Medical Officer Secretary Senior Field Research Officer Medical Officer Trainee Programmer Programmer Sociologist Field Research Officer Medical Officer Trainee Programmer Medical Officer Senior Field Research Officer Programmer Computer Analyst Medical Officer Computer Operator (Acting) Programmer Computer Manager Trainee Programmer Programmer Programmer/Anal-st Demographer Sociologist Senior Computer Operator Trainee Programmer Trainee Programmer Senior Statistical Officer Statistical Officer Medical Records Assistant Programmer/Analyst Executive Secretary Senior Field Research Officer Secretary Computer Operator Endocrinologist Research Associate (Part-time) Sanior Statistical Officer Matlab Field Station Head Epidemiologist

ANNUAL REPORT 3

NUTRITION PROGRAMME

* Zulfia Ahmed, MA K.A. AI-Mahmud, MSc (Vet)

'Ahmed Nurul Alam, MBBS, PhD Md. Akbar Ali, BSc Shahan Ara Begum, MSc Golak Behari Chakma Ashish Kumar Chovdhrviy MSc Sankari Das, BA Kh. Zahid Hasan, MBBS, MPH Md. Anowar Hossain, MBBS K.M. Nasirul Islam, MSc (A.H) Ferdous Jahan, MSc

Obaida Kabir, BA

Nilufer Khan

Ayesha Molla, MSc, PhD

* Zahid Mozaffar, MSc M.M.H. Munshi, MBBS, MPH Md. Yeakub Patwary, MA M. Abdur Rahim, BSc A.S.M Hamidur Rahman, MSc (Vet. Sc.) M. Muljbut Ralinan. MSc Najma Rizvi, MA(Geog), MA(Anthro), PhD Farida Sultana

SM.A. Wahed, BSc

DISEASE TRANSMISSION PROGRAMME

Waseque Uddin Ahmed Qazi Shafi Ahmed, MSc Saiyeda Qudsiya Akhtar, MSc, PhD

* Soheli Akhter, MSc

Khorshed Alam, BSc

A.R.M. Abdul Alim, BSc

Md. Ansaruzzaman, BSc

" Nilufer Atiq, MSc

Hasina Banu, MA, MS

Bidyut Banerjee

Saleha Chowdhury, BA

Roger Glass, MD MPH

* Khaleda Haider, MSc Md. Moshaddeque Hossain, MBBS

M. lmdadul Hug, MSc, DBact, PhD *Anwarul Hug, MSc

M.U. Khan, MBBS, DPH A.K.M. Golam Kibriya

Prabashi Mahmud

M A SalAk Mian

L.N. Mutanda, PhD

*Md. Zeaur Rahim, MSc

* Suhas C. Sanyal, MD, PhD

Md. Shahidullah Nigar Sayem Shahid, MBBS, MSc, DPH

ANNUAL REPORT 4

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh USA Bangladesh Bangladesh

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh USA Bangladesh Bangladc.sh

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Kenya Bangladesh India Bangladesh Bangladesh

Research Officer Animal Resources Branch Head Clinician Biochemistry Branch Head Research Officer Senior Staff Nurse Research Officer Field Research Officer Epidemiologist Medical Officer Animal Husbandry Officer Research Officer Secretary Secretary Biochemist-Nutritionist Research Officer Teknaf Field Station Head Senior Field Research Officer Research Officer Veterinary Officer Senior Research Officer Nutritionist- Ant hropologist Secretary Senior Research Officer

Se. or Research Officer Senior Research Officer Microbiologist Senior Research Officer Senior Research Offic3r Senior Research Officer Research Officer Research Officer Senior Field Research Officer Secretary Secretary Epidemiologist Senior Research Officer Research Trainee (Clinical

Epidemiology) Microbiologist Research Officer Epidemiologist Senior Research Officer Secretary Research Officer Microbiologist Research Trainee Microbiologist Field Research Officer Epidemiologist

http:Bangladc.sh

HOST DEFENSE PROGRAMME

Ansaruddin Ahmed, M BBS

Md. Showkat Ali, MSc

* Leif A. Gothefors, DSc(Med)

Md. Shamsul Huda, BA

Shahjahan Kabir. PhD

P.K. Bose Neogi, BSc

Sushama Pashi

M.B. Shamsuddin

PATHOGENESIS AND THERAPY PROGRAMME

*G. Milita Adhikari

Mafizuddin Ahmed

Shahnaz Ahmed

Syed Masud Ahmed, MBBS

Md. Nur Haque Alam, MBBS

Md. Mominul Alam, MBBS

Md. Hasan Ali, BSc, MBBS, DTCD

M. Abul Kalam Azad, MBBS

Abdul Aziz

Anita Baidya

Antali Baidya

Rita Baidya

Pradip Kumar Bardhan, MBBS

Annie A. Baroi

Mansura Begum, MBBS

Pankalini Biswas

'Nancy Boone, SRN, SCM

Florence Daring

Ignatius O'Costa

Santona D'Cruze

Madhabi Ghose

Bernard Gomes

'U. Elizabeth Gomes

Maloi A. Gomes

M. Gita Hatder E. Susharna 1alder

Smriti K. Halder

Md. Shahadat Hossain, MBBS

Md. Rafiqul Islam, MBBS, DTM&-H

Asma Khanam, MBBS, MPH

A.K.M. lqbal Kahii. MBBS

'Hosne Ara Kabir

A.K.M. Mozharul Karim, MBBS 'Md. Fazlul Karim, MBBS

Naseha Khatun, MSc

Makhduma Khatun, BSc

David Lahiry

Thelma N.S. Leifert, MD (Brazil)

Carma P. Lovely, SRN, Practical Nursing

Abdul Majid

Bangladesh Bangladesh Sweden Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh

Bangladesh Bangladesh

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh USA Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Brazil USA Bangladcsh

Immunologist Senior Research Officer Paediatrician Research Officer Immunologist Senior Research Officer Research Officer Secretary

Senior Staff Nurse Senior Research Officer (Clinical

Pathology) Secretary Clinical Research Ttainee Medical Officer Medical Officer Paediatric Physician Medical Officer Assistant Matron Senior Staff Nurse Senior Staff Nurse Senior Staff Nurse Clinical Research Physician Senior Staff Nurse Medical Officer Matron Nurse-Physician's Asstt. Senior Staff Nurse Senior X-Ray Technician Senior Staff Nurse Senior Staff Nurse Senior Staff Nurse Senior Staff Nurse Senior Staif Nurse Senior Staff Nurse Sertior Staff Nurse Senior Staff Nurse Medical Officer Clinical Researcher & Chief Physician Community Medicine Research

Physician Clinical Research Physician Senior Staff Nurse Medical Officer Medical Officer Dietician Research Officer Senior Staff Nurse Staff Clinic Physician Nurse-Physician's Asstt. Pharmacy Incharge

ANNU.,L REPORT 5

A. Majid Molla, MBBS, PhD, DHC K.M. Moniruzzaman, MBBS Manakhushi Mondal Samir Kumar Nath, MBBS Suratun Nessa Barlin Chandra Nokrek Momata H. Purification Golam Hasan Rabbani, MBBS, MPH M. Lutfor Rahman

Mahbubur Rahman, MBBS

*Hosne Ara Rahman Swapan Kumar Roy, MBBS Mabel V. Rozario Amal Kumar Saha, MBBS

*Md. Abus Salam, MBBS M.A.Sottar

* Shafiqui Alam Sarker, MBBS * Md. Shahabuddin, MBBS

Pieter SI.eelman, MD Anita Stephen Barbara Stoll, MD

*Marc J. Struelens, MD *Isabella Vesters, SRN Graduate Nuise

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh

Bangladesh Bangladesh Netherlands Bangladesh USA Belgium Belgium

Paediatrician & Gastroenterologist Medical Officer Senior Staff Nurse Medical Officer Assistant Matron Senior Staff Nurse Senior Staff Nurse Clinical Research Physician Senior Staff Nurse Medical Officer Senior Staff Nurse Clinical Research Physician Senior Staff Nurse Medical Officer Medical Officer Senior Staff Nurse Medical Officer Medical Officer Gastroenterologist Assistant Matron Paediatrician Clinical Research Physician Nurse-Physician's Asstt.

TRAINING, EXTENSION AND COMMUNICATION PROGRAMME

Hasan Shareef Ahmed, MCom R. Laila Akbar, MBBS, MPH

Meer Mushtaq Al MA, Dip PM

'Mir Motasem Ali, MA

Mir Md. Ramzan Ali

Asem Ansari, BFA

Abdul Bari, MBBS

Pierre Claquin, MD

*Eva G. Doheity

*Wirjawan Djojosugito, MD, MPH

Teresa Derozhinsky

Abu Eusof, MBBS

A.S Golam Faruque, MBBS

Cyril Gomes

* Lorraine Grocemari Md, Azizul Haque Mirza lmdadul Haque, BA, Dip PM. AIPM, LIB Farhad Hossain. MA Md. Nurul Huda, MA. DPH Md. Anower Hussain, BA Md. Sirajul Islam, MSc Khaled Jahangir, BA

* Pauline Johannessen Md. Shamsul Islam Khan, MA, Dip PM

ANNUAL REPORT 6

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh France Australia Indonesia UK Bangladesh Bangladesh Bangladesh USA Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Banglaoesh UK Bangladesh

Publiztion Officer Training Coordinctor riaining Ej Extensinn Manager (Acting) Serial Librarian Trainee Secretary Meical Illustration Cell Head Medical Officer Extension Coordinator Nurse Volunteer Coordinator Executive Secretary Team Leader, Training Training Physician (Acting) Secretary Executive Secretary Senior Field Research Officer Senior Administrative Officer Librarian Senior Publication Officer Trainee Secretary Senior Research Officer Secretary Executive Secretary Library EtFublication Branch Head

*Md. Ali Arshad Meah, BA

AS.M. Mizanur Rahman, MBBS, MSc

Shereen Rahrnan, MA

*A. Khayer Ubaidur Rob, MS

Sharon Sargeant

Sunil Sukla, BFA

FINANCE, ADMINISTRATION & RESOURCES

K. Alauddin Ahmed, BA

Ashrafuddin Ahmed, MSc, Engr (Mech)

Badruddin Ahmed, MBA

Md. Mahbubul Alam, BSc

Chowdhury S. Alam

A.K. Azad, MA, LLB

Judith Chowdhury

Sultana Chowdhury, BA

* Swapa-i Kumar Das

Md. Abul Hashem

Md. Shamsul Hoque, MCom

M.A. Jabbai

*M, Rahman Khalili.ACA

Taj Farhana Khan, BSc

R.N. Majumder

S.AA. Abdul Matin, BCom

*Jean Mecartney

Noor Mohd. Mermalat

Shamima Moin, MCom, MBA

M. Golam Morshed, MA, LLB

* Belayet Hussain Patwary, CA(Int.)

Md. Mujibur Rahman

Md. Mizanur Rahman, MCom

Mofzalur Rahman

*Mahbubur Rahman * Salma Rahman, BA

A. Razzaque

Bejoy R.Saha, MBA, Dip PM

*A.K.Md. Abdus Samad, MCom

"Shipan Kumar Sarkei, BCom

Mohd. Jalil Sarker

A.F. Sarker, MSc (CE). PEng K.A. Shaheed Md. Siddique

*Mobarak Ali Sikder

R.H. Sircar M. Sobhani

Suzanne Smith. AB

'New appointment in 1981 :*Left during 1981 "Leave of absence

Bangladesh Secretary Bangladesh CI nician/Epidemiologist Bangladesh Associate Editor Bangladesh Statistician/Demographer Bangladesh Secretary Bangladesh Medical Illustration Asstt

DEVELOPMENT

Personnel & G.S Branch Head Maintenance Branch Head Cost Accounting Head Procurement Offi'er Secretary Public Relations Et Information

Officer Executive Secretary Secretary Secretary Senior Accounts Officer Senior Accounts Officer Senior Personnel Officer Financial Accounting Head Secretary Senior Procuremeni Officer Accnunts Officer Executve Secretary Senior Technical Officer (Acting) Budget Accounting Head Supply Bianch Head Financial Account Head Senior Estate Officer Senior Accounts Officer Technical Officer Accounts Officer Secretary Senior Technical Officer Senior Personnel Officer Senior Accounts Officer Secretary Secretary Engineering Consultant Senior Property Control Officer Technical Olficer Accouns Olficer Secretary Bin-Engineering Cell Head Development Officer

ANNUAL REPORT 7

Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh

Australia Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh USA Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh Canada Bangladesh Bangladesh Bangladesh Bangladesh Bangladesh USA

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71 01

INTRODUCTION

[he year 1981 was a productive one at the International Centre for Diarrhoeal Disease Research, Bangladesh. Not only was a great deal of successful research carried out but also the reorganization of the Centre from its former character of a bilateral project to that of a full - fledged international organization was completed. There wete about 80 publications during 1981 in international scientific journals or the internal publications series. In addition to this, no less than 119 abstracts, letters and talks (reflecting the work in progress) saw the light of day. We are confident that 1982 will see a significant increase ini the level of such activity.

The Training Programme has matured and has convened four international courses, and four workshops or courses within Bangla-desh. The Chandpur Extension Project has shown considerable progress and a new initiative in Maternal Child Health-Family Planning has been implemented in Munshi-ganj in cooperation with the Government of Bangladesh and supported by the Federal Republic of Germany. The first joint projects

with the Government of Bangladesh will begin in 1983 and will be funded by UNFPA in two new arees. We hope that the knowledge gained in our controlled study areas in Matlab will be applied through the health system.

Improvement of health and an increased standard of living are general goalE for all developing countries. The Teknaf Water Intervention Study has been in progress for eighteen months and shows the impact of the interventions selected on the transmission of diarrhoeal diseases.

A study confirming the utility of substituting rice for glucose or sucrose, as a basis for the oral rehydration solution, has been completed and its extension to hospital and field populations has become a top priority in 1982. New methods of identifying diarrhoea-causing bacteria have been introduced in collaboration with the Microbiological Institute of Osaka, Japan and with Harvard University and the University of Washington in Seattle, Washington, U.S.A.

ANNUAL REPORT 9

We have completed the necessary work on a new financial system and it has been im-plemented with the use of the Centre's own computer. This now allows for accurate budgeting and the best utilization of resources

The foundations for a new building have been completed on schedule and it is expected that the ground floor will be ready to accom-modate the hosptal and clinical research facilities by mid-1982.

There have been other significant improve-rnents in equipment and facilities during the year, including the installation of a new ultracentrifuge and the replacement of many of the old fuel-inefficient vehicles by new diesel-powered models.

Dr. Thomas C.Butler has joined our senior staff as Programme Head for Pathogenesis and Therapy and Host Defense. Dr. S.C. Sanyal, a visitinig Professor from India also joined ICDDR,B during 1981. Three members of the scientific staff, Drs. L Gothefors, S. Becker and D. Wirjawan completed their assignments and left. The Centre is still re-latively snort-staffed in scientific leadership positions which are essential for fully vigorous prograrnmes.

During the year four new countr:es and agencies joined as participants in the Centre's work; two governments renewed contri-butions to the Centre's activities and facilities and there were 12 continuing doiiors.

An external scientific re';ew was carried out duiing June as manrdated by the Ordinance of the Centre. This review was most helpful, being not only generally positive in nature, but also because i: pointed out areas where improvements could be made.

During the year 1981, the Centre collaborated closely with the World Health Organization in hosting six courses and 14 fellows. Members of the senior staff have participated in both Regional and Global Steering Committees for the Control Programme of Diar-

ANNUAL REPORT 10

rhoeal Diseases.The Centre much appreciated the excellent cooperation of the local office of the WHO in Dacca and of the Regional office in New Delhi.

The Board of Trustees met twiceduring 1981 and passed a number of resolutions relevant to the management of the Centre. Several members of the Board participated actively in training and scientific activities. Mr. Michael F.L. Goon from Malaysia was recruited for the top financial and administrative position, and will join the Centre in March 1982. It is expected that financia! and logistic supports for the scientific and training programmes will be more efficient in 1982, and will steadily improve the cost-effectiveness of the Centre's activities in all areas. The BoarrJ of Trustees approved a budget of US $6.5 million, which is an additional US $1.5 million above currently available funds. This figure is almost US $1 million short of requirements projected in the Five-Year-Programme Budget: staff and facilities will be put to optimal use only if the Five-Year- Programme Budget is realized This indicates that 1982 will be a year of significant constraints in which activities will have to be carefully selected.

In 1981 the Centre initiated a small project in Kenya to ascertain the types of Rotavirus prevalent in East Africa as compared to those in Bangladesh. Expertise to help solve problems in diarrhoeal diseases in several Middle Eastern countries has been requested during 1982.

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The most important projects of the Corn-munity Services Reseaich Programme remain the Matlab Dermographic Surveillance System and the intervention linking simple primary health care to family planning measures in the population served by the DSS. The improvement in health and reduction in popula{ion growth noted in last year's Annual Re-

tiongroth astntedinears AnualRe-port have been sustained for the whole periodof 1981 with no new inputs,

During 1982 the health setices provided

by the Community Health Worker will be

by te Cmmuity Wrkerwilealh be

enhanced to include immunization against diseases which cause the most morbidity and mortality, improved antenatal care, and a nutrition education programme paying particular attention to the period of breast feeding and weaning. The intervention study will examine whether improvements in basic health services that save children's and mothers' lives can increase acceptance of fertility control measures. Although a very rapid increase in acceptance of contraceptive measures was seen during the first nine months of 1979 when maternal child health was linked with family planning, this achieve-ment was concentrated mainly within the segment of population already willing to participate in such programmes. The challenge

now is to recruit mothers and fami;ies who are relatively resistant to the idea of controlled family size and to understand the underlying factors contributing to areal variation in contraceptive practice.

There is a growing world-wide interest in docunmenting socio-economic differentials inmortalingT ocio-economidy ffrea bntismortality. The Matlab study area has been chosen as one of five case studies on mortality sponsored by the World Health Organizationand the United Nations Population Division. The tour other countries providing case Tue a r ri en Seng and studies are Sri Lanka, Kenya, Senegal and

Guatemala (INCAP). In order to monitor mortality and morbidity in developing ccuntries, the use of lay-reporting is being increasingly advocated. Studies have been set up using symptom lists to improve the "cause of death" reporting of the Demographic Surveillance System. The factors relating morbidity and nutrition are also under study.

A majoi study comparing the standard formula for oral rehydration solution advocated by WHO with a simple salt-sugar solution has been completed. This study covered a population of 80,000 people and the results are now under analysis. Initial results indicate

A course to enhance sklls in evaluating held projects was ointly sponsored by ICDDR,B and WHO. The course A was attended by scientists from six countries

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that there v.vas no difference in hospitalization rates or mortality between the groups, but there were significantly lower hospitalization rates ii both the oral hydration groups as compared to populations in other areas. (How-ever, it must be borne in mind that the presence of health workers in the treatment area, one of whose functions is to refer people to the treatment centre, could have contributed to the decrease.) In this study, the whole population is covered by the ambLulance system developed over many years by the Centre in the Matlab area, hence mortality due to acute watery diairhoea is very infrequent in tie whole of the study area.

Processing cf these large data sets requires ready access to -.computer. During 1981 the IBM Systems 34 Computer has been managed ard run by locally hired staff trained either in Bangladesh or abroad. On-the-job training at the Centre has been undertaken with the assistance of the United Nations Statistical Office and a collaborative arrangement with the University of Namur Bu!lgium. Appropriate software to permit analysis of data has been and is being developed A cuirent dud updated population register is being established for the Matlab population. Large data sets have been transleired back to the Centre hli the Johns Hopkins University in Baltimore. However, for data analysis requiring more powerlul scenthic computer capacity, ariangements wi the Asian Institute of Technology in Bangkok have been worked Out, and plans are being discussed with the Mahidol University in Bangkok for access to their larger computers. The Engineering University's IBM 370 in Dacca has also been utilized, but technical problems have limited its effec-tive use for data analysis up to the plesent tie In view of the growing computer reqLire. ments-both scientific and administrative and the proven capacity of locally hired staff to run the S-34, the Centre is taking steps to purchase a large, scientifically oriented com-puter.

Ready access to the data sets has permitted analysis by our own scientific staff and pro-

ANNUAL REPORT 14

vides the opportunity for Fellows from outside Bangladesh to come and carry out projects here at the Centre, addressing critical issues relating to health in developing countries. Scientists from national institutions are also encouraged to utilize ICDDR,B data sets for their own research and training and several collaborative research projects are now being undertaken. Among those who have recently comploted their training are Dr. R. Bairagi of the Institute of Statistical Research and Training, Dacca who has received his Ph.D. from Johns Hopkins University on "Alternative Anthropometric Indicators of Nutrition of Young Children", and Dr. K.M.A. Aziz whc has received his Ph.D. from Rajshahi University. His thesis topic was "Sex socialization aid fertility".

Several members of the Community Services Research Working Group are now abroad undergoing training ' develop their capacities

anaisi on atacstsor pursueu ergoingdata analysiss Mat,bd ' data sets using computer and professional facilities not available here. Among institutior at which members are under training or undr.rtaking research are the Australian Natirnal Uiversity and the London School of Hygiene and Tropical Medicine. In-depth analysis of Matlab data is being undertaken at Princeton and the Institut National d'Etudes Demograph(iues In Paris.

In addition to research activities, the Coinmunity Services Research Programme together with the Training Branch designed and carried out a course on research evaluation from 7th18th September. This course was designed to enhance skills in evaluating field projects. Scientists from Malaysia, Indonesia, Thailand, Nigeria, India and tie Philippines participated. The visiting facu:ty included, as Associate Directors of the course, Dr. Patrick Vaughan from the London School of Hygiane and Tropical Medicine and Dr. Lado Ruzicka from the Australian National University. Other staff members were Dr. Bogdan Wotjnaik from the National Institute of Hygiene, Poland and Dr. Shushum Bhatia from Johns Hopkins

University, Baltimore. The course was jointly sponsored by lCDDR,B and the World Hedith Organization. Practical examples of evaluation wereprovidedbasedonthewealthoflCDDR,B experience.

The Community Services Research Pro-gramme also supported the initiation of a lew extension project in the Munshiganj area in collaboration with the Government of Bangla-desh and funded by the Federal Republic of

Germany. The aim of this initiative is to evaluate through simplified surveillance methods the eltectiveness of the health and family planning services. The experience gained from this project will be applied to Extension projects for 1982 planned jointly by ICDDR,B and the Government of Bangladesh. Technical assistance to voluntary agencies engaged in oral rehydration projects, such as the Bangladesh Rurai Advancement Committee, is also provided under the programme.

Itnkinrq sirnole prirniary hiealth care measures vili poipulationcontrolacLtivties in the Mat',b area resulted in improvement In health and red-'rttn1-in population growth.The doctors aridsurveil'ance workers of the area maintained a close contact with the local population

ANNUAL REPORT 15

*~~/4/~ o'

NUT~fKiO

During 1981 the Nutrition Programme carried out a series of clinical studies with careful laboratory analysis, and pursued its main field intervention in the Teknaf Field Station. In Teknaf a population of approxi-mately 50,000 has been under demographic surveillance since 1975,A Water and Sanita-tiun Intervention Projcct covering two com-munities with populations of 2,000 each was set up. The study community was provided with hand-pumped tubewells, and a program-me of health education to maxilize the use of ilbewell water for all personal rnd domestic purposes. All households in the study area will soon be provided with water-seal latrines I he goal is to reduce to the maximum extent tasihle, diarrhoeal morbidity and mortalrt" and parasitic loads with these simple interven-lions. The hypothesis is that these interventions will improve the nutritional status and health of children under five. The comparison community will be under the same intensive surveillance as the study area, the diarrhoeal morbidity and mortality being recorded every week, but the only intervention will be care of the ill at the diarrhoea treatment cn-tre or by oral renydration as utilized by the rest of the population of the Teknaf area. Faecal con-tamiation of tubewells during the monsoon and dry season has been measured and the results are shown in Figure 1. Results of the intevution measures are expected during 1982.

The effect of diarrhoea on the intake of food has been studied (Figure 2). Absorption of micronutrients, particularly vitamin A and zinc, and the macrorutrients. I ,,tat, protein and carbohydrate, occurred both in the acute and recovery stages, This suggests that vitamin A can be provided by mouth during diarrhoea to ensure effective absorption. Since zinc is linked with vitamin A metabolism and possibly with susceptibility to diarrhoea, studies have been carried out on this metal. In a stdy in-volving normal Bangladeshi subjects and patients with diarrhoea, it was found that the serum zinc level of !iarrhoea patients was significantly lower than the level found in normal volunteers (Figire 3). Whether this is

100 90

- 1979o----o YearYear 1980 70

Z 60 01 :50 / E 8 40

30 // \

20/ 10 ,

0 Jc, 1 0 Ma, Ai. MayJun.Jul. Aug Sop. Oct Nov.Doc.

Months

Figure 1. A'ean colilorm count by months ir 1979, 1980.

caused by the diarrhoea or malnutritior associated with diarrhoea has not yet beer clarified. The relationship between zinc deficiency and diarrhoea and its consequences ir vitamin A metabolism will be explored durinc 1982.

The importance of vitamin A deficiency in the field was emphasized by two studies in which

the Matlab population was surveyed fot evidence of corneal vitamin A deficiency manifest by keratomalacia or drying of the sclerae. It was found that oftcr mealses there was an increase in dysentery and evidence of scleral drying thus linking measles, dysentery and vitamin A deficiency. In a larger study involving apopulation of 175,000, it was found that there were more than 580 people with impaired vision per 100,000 study population of which 254 cases were due to corneal opacity. Of this group 11% were due to suspected keratomalacia from vitamin A deficiency. Night blindness wasfoundto be highly associated with diarrhoea. Further studies to ensure aiequate vitamin A intake during and

ANNUAL REPORT 17

~14

~ juff

Attedince;at a diarrhoea clinic by women andehildien is directly relatedro the distance of the ch c e ohome. Coi'sequenttly more complicationis awl deaths are seen amongpatietvs lrr 'w at a Yreater distance from a chmc But with use of oral rehyaratioti solution In the home, eotl/icatios :irlslny ot of dehydration ca be reduced.

I 'Indicates Stoppage of diarrhoea.

135

120 4 4 0'

71)

30.L (L.C)

Days 1 2 3 4 5 S 7 8 222324 1 2 3 4 5 6 7 8 2223 24 1 2 3 4 5 6 7 8 222324

CHOLERA E. COLI ROTA VIRUS

Figu:e 2. Obseived caloriei,ntake in study period of 8 days atd late convalescent (L.C.) stage for each group (mean -, SEM)

ANNUAL REPORT 18

O-o Normal Subjects TABLE 1 ,--Diorhoeal Patients LOEFFICIENT OF ABSORPTION (MEAN+ISD)

4a

30

20 C.

10

0 6-79 12-13 9 26+

Figure 3: Distribution curve representing the serum level of 100 nomial adults and 62 diarrhoea/patients

after diarrhoea will be underlaken during 1982.

The excellent absorption of carbohydrate during all kinds of diarrhoea was further confirmed during 1981, unlike absorption of fat and protein which was more alfectcl. When comparing absorption during acute and recovery stzges there was improvement in the absoi-ption of all nutrients two weeks after recovery from diarrhoea. Shigellosis and rotavirus had greater impact on food absorption than did cholera or enterotoxigenic diarrhoeal diseases (Table 1 ).

OF CARBOHYDRATE DURING ACUTE (A) DIAR-RHOEA AND AFTER 2 (R I) AND 8 WEEKS (R2)

OF RECOVERY

Cocficiet of Absorption

Aetiology A RI R2 Cholera (29) Rotavirus (17)

87.8! 195 77.81237

92.8 t69 898'5.7

92.1 t-4.6 85.8.:11.8

ETEC (13) 91.2'-5.6 8S-7,92 91 r59 Shigella (9) 76.5 ;26.5 83.3 18.0 92.1 L3.3

The Teknal Project was initiated in 1974 after an outbreak of Shigella dysenteriae type 1 in the area. Because of the increasing

evidence linking shigellosis Io malnutrition following diarrhoea, an international conference on shigella was convened in Cox's Bazar with field visits to the Teknaf area. Scientists from seven countries actively carrying out research on shigeilosis attended the conference. It is anticipated that the impetus from this conference will lead to ie,eased emphasis on research on shigella at ICDDR,B and also in laboratories of other participating countries. The importance of shigellosis as a sequelae to measles and its relevance to nutrition were brought out ard are being investigated further.

A conference on shigellosis was held in Cox's Baza, and was .ittendediyscientists from Bangladesh, China, CostaRica, Switzerland, Poland USA and the World HealthOrganization.

.4Jr .

--- 4>_,o - . ,.- 2 E

4-t-. .

A VA

" 57 :'~~~~~ll,)ii: j ~~It-ll,01

During 1981 the Disease Transmission Programme was concerned with the further characterization of new causative agents of diarrhoeal disease; improvement of methods for recognizing enteropathogens; a ield study of the B subunit of cholera enterotoxi asa candidate component for oral cholera vaccine, studies on transmission of cholera by water and the relationship to other vibnios found in water; and continuing the suivillance of patients coming to ICDDR.B Tieotment Centre, Dacca.

Studies on the epidemiology of Ciflh' bacter /e/ur have been going on at ICDDRB since 1980 Canmpylobacter was detected five Matlinb. In Some patil e y ofens C,Jelw

bact r infection and diarrhoea have be-en associated with an increase in convalescent liiti . by complenirnt fixation ttst. Studies Iive hol ondortnken to exarnine the pathoger yii i lr~takertolxamie he CoilaOericity

oftidfie5 aInpyo11ao i slt withC udp laboratcrries

investigatin(g (',orylohacter iii Belgui . Swe.den, Caiilrilith IJ .K. and. thet US A StlinIS Isoheltd lion1) Math1[) illn(ot'ncerplacesin Ban ladesh nre aintgn thredmanyby

e r n01 laboratories currently wvori ri on Campy/obacter; ICDDR B '.11reisi reio.,inhlo strauis for testing here. A major iesearivh plai has bfon drteinhe r. S arseC. lSan,w ndrafted arnd Dr. Suhas C. Sanyal, a visiting Idto e therji wicth otheriiasi of11V1H r ytI CDInda tRogseti wi hei ll annieip t h,

tinguish the differet strains of Canipy'/nbc-

tei. The Centre will sponsor an international conference on Campylcbactet in 1983.

Search for othei new pathogens and their characterization has been going on, particu-laily in the area of Aeromonas, Pleslomoras, adenovirus and other viirio species. Yers,,ta entewocohtica could not be isolated from patients suspected of having this organism, despite the fact that it was easily isolated from

Two new methods suitable for isolation of enteropathogens in field situations were

developed at the Centre this year. The first is a simple method incorporating antiserum in iedium for the recognition of enterotoxigenic E. co/ which secrete heat labile enterotoxin. This method was set up by Dr. T. Honda of the Institute for Microbial Diseases (Biken), flsaka, Japan in collaboration with wokers at ICDDR,B. The second method involves the use of single stianded P32 labelled DNA genome probe for detection of LT and ST. This method was used successfully to recognize, directly from the stool, E. co/i capable of producing these enterotoxins. This bacteria causes the bulk of diarrhoea in Bangladesh. These methods will be adapted for use in field situations during 1982 and will greatlyfacilitate understanding of the epidemiologyof enterotoxigenic E.coli diarrhoea. Studies on

serotyping of Rotavirus continued during this year. It was found that Rotavirus could be iso!ated from hand washings of patients'attendants, demonstrating the presence ofthe virus on the hands of family members and

the fact that itcan be traced from the patient to another point in the environment.

Basic studies on characterization of plasiiids responsible for resistance in V. cholerae continued in 1981. A new outbreak of V.

cho/erae 01 El Tor, resistant to gentamycin as well as to ampicillin, kanamycin and teiracy(line, was detected in Dacca during 1981.A total of 264 out of 2880 V. cholerae 01

isolated were tested and found to be resistant to four antibiotics( Table 2). Rfactors from the ten iusistant strains listed were plasmid borne and had identical transfer factors. The outbreak was a new one and did not represent a reappearance of the previous multiple resistant Vho/erae l Chloramphenicolresistart Sa/monella typhi Vi phage type A was isolated for the first time in Bangladesh from patients admitted to the hospitai during the year 1981.

A study utilizing the binding subunit of cholera toxin as a blocking and immunizing agent was conducted this year. It was administered oral!y, had few side reactions and hasbeen given to family members who are at high risk of cholera;240 families were studied and

ANNUAL REPORT 21

TABLE 2 levels and the protective effect of antibodies

DRUG RESISTANCE irJ Vibno cho/erae in breast milk have been carried out.

BIOTYPE EL TOR FROM BANGLADESH A surveillance system has been established at the ICDDR,B Treatment Centie, Dacca and is now providing a carefully studied subset ofSeovar No. RTypo No . all patients entering this hospital. Some of the

Ogawa 264 AKTG 264 results from this study are illustrated in Table 3. . . .. ... The system also allows investigators to have a. ..

continually available random sampling of Re, 'sur, ,y, ,,, h MIC ,, A A,,:,I,, 60C)C K diarrhoea patients for other studies which canKanamyclr (6400),. T Tc;Iracy(:hn)(8T0-16() (50 100). G.-G,!tam~ cm be carried out with minimal extra cost when

linked to the surveillance studies. appioximately 30% of family members became culture positive, half developig symptoms of The Treatment Centre in Dacca during 1981 diarrhoea. Analysis of the results of this trial was under the supervision of the Disease is expected to be completed in 1982. Further Transmission Programme. During this period studies on the spread of cholera within fatai- a study has shown the cost-effectiveness and lies, its r.lation to blood groups, salivary IgA efficacy of oral rehydration therapy (Table 4).

/CDDR.Bhost;diaconference on experiil;nta/cholera vacciies, v hich was attended by SCienllSts frol Bar'(,,Idesh, Hungary. Italy. Japan, Kenya. Kuwait. Nigeria Switzerland USA and the World Health Organization.

*k y '5.!

__

The Microbiology Branch under this Pio-gramme established a counter-immuno electrophoresis techniqie for the identification of antigenic components of various organisms. During 1982 this method will be applied studying respiratory complicatio:ns in diar-rhoea in relation to Haemophilus influenza and Pneumococcus.

ICDDR,B hosted a major international conference on cholera vaccines in May. This conference brought together scientists from countries working on candidate vaccines for

cholera. The results of this meeting suggest that the Centre must develop competence in microbial genetics and improve its ability to study living oral vaccine strains in tne future. This is particularly emphasized by the success-ful development of a highly effective oralvaccine against typhoid which has been field-

tested during the past few years.

TABLE 3

ISOLATION RATE OF PATHOGENS, ICDDR,B HOSPITAL SURVEILLANCE, DACCA, BANGLA-

DESH, DECEMBER 1979-NOVEMBER 1980

Pathogen Rate/1000 Patients'

Enterotoxigenic E.co/i 200 Rotavirus 194 Shqel/a 116Campylobacterjejuni 116Enamoeba h/stolyt/Ica 61

Giardia lambia 56 Vibrio cholerae group 0:1 55 Non-group j1 Vibrlos 11 Salmonella 6 No pathogen identified 176

'N-3550 patients for Salmonella. Shigella and Vibros, 3230 fur rotavirus, 3123 for ETEC, 3038 for Campylobacter and 2246 for E iisrolVotca and G lanblia

TABLE 4

COMPARISON OF COST PER PATIENT FOR THE FIRST FIVE MONTHS OF THE YEARS 1980 & 1981

Scalp Vein Needle IV Fluids including IVsets

(litres) ORS (litres) Staff Commitment X-Ray & Laboratory Tests Medicine and other supplies Food

Total Cost per Patient

Saving

1980 1981 N. 10379 N. 9897

No. of units

Cost perunit

Total Cost

No. of units

Cost perunit

Total Cost

(US S) (US $) (US $) (US $)

12,610 0.85 10,718 3,811 0.85 3,240

13,077 2.81 36,749 6,433 2.81 18,077 1,038 0.11 114 11,480 0.11 1,263

9,009 10,473 4,525 4,713 5,031 3,667 2,449 2,316

68,595 43,749 6.61 4.42

33.13%

ANNUAL REPORT 23

A fild- test of a tion - toic stbunit of ChO/V/d (0 ~I/ P/1 ith be a Piof'iisiii iiWiloooilyqabost choleril whlen

I*

HOST DEFENSE PROGRAMMEi

The response uf mucosal surfaces to the antigens of Vibrio cholerae and enterotoxic E. co/i have been the main focus of the Host Defense Prc.,,amme during 1981. Studies have been c, ;d c;.!t on the composition of the outer membrinn p;-otein of both El Tor and classical biotypes of Vibrio cholerae and both serotypes of Ogawa and Inaba. A major protein band of 48,000 Daltons molecular weight was present in all strains and was shown to have lower toxicity in experimental animals than the lipopolysaccharide o: this organism. Studies to purify and specify the nature of this component as a possible vaccine candidate will be continued in 1982.

The factors responsible for the adhesion of Vibrio cholerae to host tissue surfaces were explored in several experimental systems including hydrophobic gels and blood cells. The importance of close association of vibrin to gut epithel 'm nas been emphasized pre-viously in studies with charcoal-bound GM, ganglioside which absorbs all toxin produced in the lumen of the gut but fails to influence the

course of cholera other than slightly during initial phases.

The cholera binding subunit has been shown to be a promising immunogen .vhen given orally to both Swedish and Bangladeshi volunteers. There have been no side effects with oral administration and few minor local reactions after intramuscular injection. Specific IgA antitoxin re:sponses have been demonstrated in 9 out ot 11 women after ora: exposure and in 9 out of 12 given 0.5mg by the intramuscular route. A study has been designed to test whether the local immune system is responsible for the termination of cholera infection. This protocol will be carried out in 1982.

International collaboration in this Programme included that with the University of G6teborg and Drs Ann Marie Svennerholm and Jan Holmgren; Dr David Sack of The Johns Hopkins University, Baltimore, Maryland, U.S.A., and with the Serum Institute of Stockholm.

,Scientstsattending the conference on cholera vaccines visited the laboratories of the ICDDR, B.

ANNUAL REPORT 25

PATHOGENESIS AND THERAP'V PROGRAMME

Simplification and refinement of oral rehydration solution was one of the main concerns of the Programme during 1981. In addition further work on the utility of chlor-promazine in reducing fluid loss and thereby the requirement for oral rehydration solution was completed. Studies on salicylate as an agent to reduce fluid loss in cholera were initiated. Studies of chronic diarrhoea and acute colitis were carried out and further investigations on the pathogenesis of cholera were made in collaboration with Keio Univer-

A visiting scientist, Dr.sity, Tokyo, Japan. Toshifumi Hibi, was able to ascertain the state of the epithelium of the duodenum by fibreoptic endoscopy during cholera and to measure its. electrolyte content. The importance of giardiasis in a periurban village was studied and the role of antibodies in pathogenesis and prevention were investigated. A randomized double blind study for a new amidinopenicil-lanic acid antibiotic, mecillinam, in shigel-losis was initiated.

The new Programme Head, Dr. Thomas Butler, joined the Centre early in November. However, even before formally taking up his appointment, h. was involved in discussions and development of research leading to a shift in programme emphasis focused on the patho-genesis of shigellosis and other invasive diar-rhoeal pathogens.

The question whether citrate or acetate can be substituted for bicarbonate in oral rehy-dration solution was settled in a study carried out at the Centre this year. Figure 4 shows the corrections of acidosis in the three groups of patients.

The effectiveness of a rice powder elec-trolyte solution in the treatment of diar-rhoea was established in a study comparing patients treated with rice electrolyte and suc-rose electrolyte formulae. In addition, a larger number of patients was treated with the rice powder electrolyte, and the loss of carbohy-drates in the stool measured. The results of this study have shown that rice serves as an excel-ient carbohydrate source for electrolyte ab-

30

,25

o~ 2E 20

N ,0

E 15

Acetate U 10 Bicarbonate

Citrate

5

01 0 4 24 48

Time (in Hrs

Results expressed in mean + SEM Flywe 4: Changes in setui bicaibonaie fin

angsb

sorption during riarrhoeal diseases observed ;n Bangladesh. This study will be accelerated with practical applications in a large scale treatment centre setting and field trials during 1982 and 1983. The use of rice in place of sucrose or glucose means that only the salts, sodium chloride, potassium chloride, and sodium bicarbonate need be packed, thus resolving the difficulties involved in packaging mixtures of sugar and salts, which have a short shclf life. An added benefit of rice based solutions is that the water in which rice is prepared is always boiled and therefore will be safe and pure. The measurement of rice is known to every village mother in rice eating countries of the world and this measurement is not critical since starch is a large molecule and does not have dilatory osmotic effects when eaten or druik. It is expected that other cereals with starch will also serve as a bosis for oral replacement solution. It is felt that the use of starch is the ultimate simplification for oral

ANNUAL REPORT 27

rehydration. The ability to substitute a non-reactive base such as citrate or acetate for bicarbonate also further simplified packaging and transporting problems.

In a paper completed but still in press it has been shown that chlorprornazine reduces the requirement for oral rehydration solution in young children with acute cholera. However, ii all causes of diarrhoea in all age groups are considered there was no effect demonstrated. An emphasis on other candidates for reduction of fluid loss will continue and several other agents will be explored in 1982 including completion of a study of salicylates and initia-tion of a study on indomethacin, chloroquirie and other agents proven effective in expeni-mental systems.

Studies of acute colitis with a fibreoptic colonscope have shown that varied patterns of colonic inflammation and ulceration occur in these diseases extending to upper levels of the colon. Analysis of materials from these studies will be performed by light and electron microscopy and will continue into 1982.

In Travellers' Diarrhoea studies, 400 patients were examined with various complaints. Approximately 75% of these presented with watery diarrhoea and 25% with a dysentery syndrome. In the study of those presenting with dysentery, Shigella was found in 26%, Campylobacter 18%, E.histalytica in 6% and no pathogens in 50% of cases. This emphasizes our lack of ability to recognize the causes of., dysentery syndrome in Bangladesh in coniparison to the better than 90% ability to recognize the cause in acute watery diarrhoea.

In a study in Nandipara, a periurban village, it was shown that Giardia co!onized infants at an early age. Early infection occurred despite breastfeeding,with the milk shown to contain anti-Giardia antibodies. The possible influence of maternal breast milk antibody on the acquisition of infection is being analysed.

The hospital and treatment centre were

partly under the supervision of the Disease

ANNUAL REPORT 28

Transmission Programme and partly under the Pathogenesis and Therapy/Host Defense Programme. The cost-effectiveness of ORT was demonstrated. The report on the hospital activities is as follows: atotal of 78,822 patients were treated during 1981 of whom 2,877 (3.6%) were admitted with complications to the general ward. Another 603 patients were admitted for research protocol studies. Deaths occurred in 401 patients or 14% of those admitted to the general wards. Analysis of the complications leading to death have been carried out and submitted for publication during 1981. In a survey of selected patients with watery diarrhoea in the treatment centre, 11,456 had darkfield examination. Of these, 3,031 were posi ,ve for Vibrio cholerae. Positive cultures for Shigella species were found in 517

Most diarr/ioea patients in f/i Treatnent Centres o WDR.8 are iaiaged ith oral re/ydrafon

therapy, administered by thppatients attendants arid supervised by paramedics. In cases of moderate to severe dehydratioti, the nurses keep a close

wlatch and if necessary consult th/ephysician-incharge

.

*

VIP

r 4S TRINN

04,

Women /roin the conninty Witil little o,00(fotnnlt education are trained by quallihedi rses ,xperien:edlin m1an,igementof diarrhoea. The trained womei recelve suppli.s of oral rehydratiion themapy packets and manage cases of diarrhoea in their own conutntunulir's

TRAINING, EXTENSION AND COMMUNICATION PROGRAMME

The Training Programme has steadily expanded its activities during the first three years cf the Centre's operation. This year four international courses were given in colabora-tion with the World Health Organization, and four courses and workshops were given in Bangladesh directed principally at training those who would be teaching and training others. In addition research training fellow-ships have been provided to six candidates from Bangladesh and 14 from outside, often under the auspices of the World Health Organi-zation. The Training Programme has col-laborated with national institutions to assist in strengthening their programmes. Theseinstitu-tions include the Dacca Medical College, the National Institute of Preventive and Social Medicine (NIPSOM), the Institute of Post

TABLE

COURSES EtWORKSHOPS

TI1 LE

1. First Asian Conference on

Drarrfoeal Diseases

2. Inter-Regional Training Course

on Diarrhoeal Diseases

Laboratory Aspects

3. Conference on Experimental

Cholera Vaccines

4. International Conference on

Shigellosis

5-6.Trainers' Training on use of

Manual on Tiectment and Prevention of Diarrhoea and

the Trainers' Guide

7. Inter-Regional Trainr.g Course on Health Services Research Evaluation

8. Inter-Regional Training Course

on Diarrhoeal Diseases: Clinical Aspects

9. Workshop to Develop Training

Modules on Diarrhoeal Diseases

10. Workshop on Ethical

Consideration in Research on Human Subjects: Special Reference to Developing Countries.

Graduate Medicine and Research (IPGMR), the Institute of Public Health Nutrition, the Paramedical Institute, the National Oral Rehydration Programme, the Atomic Energy Commission, and a variety of veluntary agencies. The Training Programme has also sponsored a series of seminar.'by staff members and visiting scientists. Scientists from 10 different countries participated in the seminar programme.

The Training Programme for 1981 can be seen in Table 5and the prospective programme for 1982 ir Table 6. The country distribution of fellows from each country is shown in Table 7 arid the seminar programme by country in Table 8.

5

HELD DURING 1981

DATE SPONSORED BY

16-21 February ICDDR,B/NICEDiWHO

23 March- WHO/ICDDR,B 3 April

6-9 April WHO/ICDDR,B

15-20 June ICDDR,B

10-14 August ICDDR,B

24-28 August

7-18 September WHO/ICDDR,B

12-23 October WHO/ICDDR,B

7-10 December ICDDR,B

14-18 December WHO/ICDDR,B

ANNUAL REPORT 31

TABLE 6

PROGRAMME FOR COURSES AND WORKSHOPS DURING 1982

TITLE DATE

1. Trainers' Training on use of Manual on Treatment 4-8 January and Prevention of Diarrhoea and Trainers' Guide (Trainers' Training Course)

2. Trainers' Training on use of Manual on Treatment 16-22 January and Prevention of Diarrhoea and Trainers' Guide (Trainers' Training Course)

3. Inter-Regional Trainiig Course or, Diarrhoeal 15-26 March Diseases: Laboratory Aspects

4. Inter-Regional Training Course on Diarhoeal 19-30 April

Diseases: Clinical Aspects

5. Trainers' Training Course 5-9 July

6. Trainers' Training Course 19-23 July

7. Course on Research Methodology 1-30 September

8. Inter-Regional Trainirg Course on Diarrhoeal 20--30 September Diseases: Epidemiological Aspects

9. International Workshop on Evaluation of Measuring 29 Novemberthe Impact of Combined Water and Sanitation 3 December Programme

Participants of a training cc,'se run by ICDDR,B see for themselves how diarrhoea is managed in the treatment centre during the practical sessions.

In implementing its international training programme the Centre had dedicated its own resources together with those of WHO and UNDP. New ground has been broken in the course of field evaluation methodologies organized by the Community Services Research Programme. It is expected that in future the Centre will lay emphasis on training individuals

from developing countries in research methodologies in the laboratory, hospital and field areas.

It has been gratifying to see that a number of participants of the courses held in the past have established programmes in their countries of origin and started to carry out research on return to their home institutions. Specific examples of developments in these directions can be seen in the Philippines, Indonesia, Vietnam and China. The development in China has been particularly interesting, where after becoming acquainted with the methodology for identifying pathogens wnich cause diar-rhoea during a course on laboratory aspects in ICDDR,B, Campylobacter has been isolated for the first time in that country during 1981.

TABLE 7

COUNI-RYWISE DISTRIBUTION OF FELLOWS

No. of Country Fellows

Burma 2

Egypt 2

India 2 Japar, 1

Nigeria 2

Philippines 1

U S A 4

TABLE 8

1981 ICDDR,B SEMINAR PROGRAMME BY COUNTRY

No. of Country Seminars

Bangladesh 16

Canada 1

Czechoslovakia 2

Indonesia 1

Japan 1

Nigeria 4

Philippines 1 Sweden 1

U S A 8

It is felt that one of the main emphases within Bangladesh should be the addition of

current knowledge on the basic sciences and

epidemiological information on diarrhoeal diseases to the medical school curriculum, so that the students may have a clear concept of diarrhoeal diseases, their mechanisms, causes and manner of spread. To this end a second workshop has been convened with faculty members from all medical colleges in Bangladesh to address the issues of this proposed change in the curriculum content.

A further initiative taken by the Government

of Bangladesh together with the ICDIR,B was to address the issues of ethics of health research in developing countries. This meeting was convened in December and has resulted in guidelines which adapt the Helsinki Declaration to the situation in Bangladesh.

ANNUAL REPORT 33

TABLE 9

COUNTRYWISE PARTICIPATION IN COURSES AND CONFERENCES -1981

No. of partici- Participants Faculty

Title of Events pants from Members from

First Asian Conference 44 Bangladnsh 20 on Diarrhoeal Diseases: India 16 16-21 February Kuwait 2

Philippines 1 S. Arabia 2 Sri Lanka 1 WHO 1 Thailand 1

Inter-Regional 12 Bangladesh 2 Uniied Kingdom Training Course on Burma 1 Denmark Diarrhoeal Diseases, China 1 WHO Laboratcry Aspects: Fiji Island 1 USA 23 March--3 April Indonesia 1

Papua New Guinea 1 Philippines 1 Sri Lanka 1 Sudan 1 Thailand 1 Vietnam 1

Conference on 41 Bangladesh 24 Experimental Hungary 1 Cholera Vaccines: Italy 1 6- 9 April Japan 2

Kuwait 1 Nigeia 3 WHO 1 LISA 7 Switzerland 1

15-20 June Poland 2

United

International 47 Bangladesh 35 Conference on China 1 Shigellosis: Japan 1

WHO 1

Kingdom 1 USA 6

Continued on page 35

ANNUAL REPORT 34

Title of Event

Inter-Regional rrainiog Course or Healt;i S wi:ces Research Evaluation 7-18 September

Inter- Regional Training Course nn Diarrhoeal Diseases;: Clinical Abpeclc. 12--- 2j uLiutLLi Japan 1

Table

No.

18

9 contd.

of parti-cipants

10

Participants trom

Bangladesh 2

India 1

Indonesia 1

Malaysia 1

Nigeria 2 Philippines 1 Poland 1 Thailand 1

Bangladesh 2

Bhutan 1

Egypt 2

Kenya 1

Papua New Kuwait 1

Guinea 1 Philippines 1 SriLanka 1 Syria I Thailand 2 U.S.A. 3 Yemen Aiab Republic 1

Faculty Members from

Australia Bargladesh U.S.A. United Kingdom

India WHO U.S.A.

Participants of a training course do practical work in the laboratory. They can then perform tests to identify the causes of diarrhoea in their own countries.

'/,

. . f . .

-.Ie /.

New initiatives were taken to extend find-ings frorn ICDDR,B's research programmes to the Government Health System of Bangladesh A project was taken LIp jointly with the Govern-ment and the Federal ,pe lie Of Geor many to carry out surveilla'rce and evaliation of thIt health status ei six thanas in Munshigarnj, Dacca District. which is adjacent to the Comilla District whene the Matlab Field Station area is located The methods developed and iilpie mented in this study will be further modified to serve as abasis for the exteisiot of amate nal child health an d family planning programnie to be sponsored jointly with the Government of Bangladesh in tlhree new thanas in 1982. The objectives of the Munshiganj Prolect were as follows:

A. To document the denographic charac-teristics of Munshliiari Suh-Division at the beginning of the German tchniical assistance, and demographic changes in the courseu of lhe project

B, To identify the leading causes of maternal mortaity, and moitality and Morbidrry among Chl lUlln JIidel ive yearIS of ditg,

C. Todocumentthe patteimsof conitraceptive behavioul aint correlates to irciud(e idicators of institutional commitment to pro(rallmlrt mplemention

D. To conduct operational research by

--measulirig the community health needs, -measuring the guaritiry andIuality of

health resources CUrrently available for the service programme,

health services aiderrtifyir ze erviewayd in which fy

are r-er'ontly nitri/ed to satisfy effective do-mand for ccne; arnd

-- tuartilying specific activitie-, of heahhr centres both at the centre and at co,mnunity level.

E. To make specific 'ecommendatiorrs to improve the present situation.

The work on this project is going according to schedule and the analysis will be completed in the middle of 1982.

The Chandpur comnunity training project has continued through 1981 and the goal has heen to introduce oral ehydration solution for the treatment of diarrhoea in the comrnenity without any maternal or other services delivered directly by ICDDR,B staff A vaiiety of ways have been used iluding training of village practitioners, and direct training of vilige volunteers with the help of posters and other educational material. Evaluation of this ptroject was carried out drIlonig 1981. The first )Oint was to assess the knowledge olO RT ailoiig mothers, village pra'titioners and the general public, and the extent of use of ORT i1 tie comnmunity when diaiihoea stikes. lie second point was to evaluate the safety of the. composition of the ORT Soil'tion pie irmtd by mothers In the prloect area The hiings of tills evaluation Indicale tMal the village praction is and fmil/y nIiernbul., i iriothels, prov to be the group 1iost elfctI ,e In iii,1itidil( eiSOades Of dfarrhoea. It wias h)wevr e(shr less liqe consuming ai regu1res loss rranpowur to organize and train voflei ptictltiom Is thrill amilly Ilelllbel5 alnd.r

rLti, 'IfS. ThiIS vI; beCause IfIe strategy for training lamily numerhls was to (o directly to the holse an1f show how solutions CAii he made and used, while village practitioners (rooil he birioglt lor one week nteiisr\,, r,(iilseS III ()loups of twenty or IuOre Vviih

rjesults. Though it was easer to train villagje oractitioners and they contnued tc use ORS, family merrbers used more ORS and sustained use of larger amounts for each episode. Training materials were found to besatisfactory but substantial improvements Could be madie arid further investigation was needed to determine the type of training nate iiris most effective in Bangladesh.

ANNUAL REPORT 36

Eminent persons from different walks of life and distinguished medical professionals discussed the ethical conduct of research on human subjects, especially in developing countries, during a workshop jointly sponsored bythe Government of Bangladesh, Bangladesh Medical Research Council, WHO dnd ICDDR, B.

Ethical Review Committee:

Following a resolution of the ICDDR,B Board of Trustees and the provisions of the Ordinance establishing the Centre, Ethicalan Review Committee (ERC) started functioning in order to regulate research involving human subjects. The objectives of this Committee are to examine and monitor the ethical as-pects of the research protocols on human subjects. There are twelve members represen-ting different disciplines, only three of whom are from ICDDR,B. -The list of members is as follows : ICDDR,B Members: Dr. K.M.S. Aziz

(Basic Scientist & Chairman) Dr. M. Mujibur Rahaman

(Clinician Et Reliuving Chairman)

Dr. Brian Seaton

(Laboratory Scientist)Other Members: Dr. T.A. Chowdhury

(BMRC Representative) Dr. Humayun K.M.A. Hye

(Pharmacologist) Dr. Z. Sestak

(WHO Representative) Dr. Khaleda Banu

(Paediatrician) Dr. Sufia Ahmed

(Woman & Non-scientific Member)

Mr. Md. Mofazzal Hussain Khan (Religious Representative)

Mr. K.Z. Alam (Legal Professional)

ANNUAL REPORT 37

Mrs. Husnara Kamal (Behavioural Scientist)

Mrs. Tahrunnesa Abdullah (Behavioural Scientist)

According to the recommendations of the meeting of the Ethical Review Committee held in June 1980, a "Workshop on Ethical Consideration in Research on Human Sub-jects: Special Reference to Developing Coun-tries" was held from 14-19 December, 1981. The Workshop was jointly sponsored by the Government of Bangladesh, BMRC, WHO and the ICDDR,B. The Workshop was organ-ized on a national scale and the dates were chosen at the request of WHO which was able to fund the Workshop partially if it were held in 1981 and on an in-country basis. At the conclusion of the Workshop, recom-mendations were made regarding the guide-lines of ethical considerations in research on human subjects, with particular reference to developing countries in the spirit of the Helsiniki DeclaraJon and its subsequent amendments.

Research Review Committee:

According to adecision taken in its meeting held on 19 March 1981 the Research Review Committee was reorganized to include, in addition to the existing members, the Scientitic Programme Heads and three scientists from ICDDR,B for a one-year term. Renewal or rotation of membership would be decided by the Committee. The Committee is now composed of Drs. W.B. Greenough It, M.M. Rahaman, K.M.S. Aziz, A.M. Molla, A.R. Samadi, Stan D'Souza, Thomas Butler, Najma Rizvi and M.U. Khan. The purpose of this Committee is to review the scientific aspects of ,he research protocols, and to examine the scientific values, significance and relevance of each protocol, the capabilit' of the investigators proposing the research, feasibi-

Dr. I.D. Ladnyl, Assistant Director General, WHO during his visit to ICDDRB to participate in the 1st Asian Conference on Diarrhoeal Disease, reviews ICDDR B publications.

...

lity of the project at ICDDR,B, evaluation of the budget and the plan for data analysis. The Committee meets once a month generally a few days after the Ethical Review Committee.

During 1981, the Committee reviewed 53 protocols of which 42 were approved. The protocols submitted to the Committee during

1981 are as follows:

Identification of colonization factors (CFA) in E. coli.

Effect of mecillinam in the treatment of shigellosis,

Giardiasis and amoubiasis among expatriates in Dacca, Bangiadesh. Clinical, epidemiological, im-munologic and tieatment aspects, a prospective study.

Investigations on the biological activities of lipopolysaccharides and cholera toxin/toxoid available in the routinely manufactured anti-cholera vaccines.

Use of base-precursors as a substitute for bicarbonte in the oral rehydration solution.

Study of seasonal variation of cholera in Dacca over

the past eighteen years.

Cholera seasonality and geographical patterns in

Matlab 1966-1979.

Does domestic animal determine neonatal deaths.

Pilot study of the family life cycle in a rural area of Bangladesh.

Determinants of return migration in the DSS, Matlab.

in theCharacterization of antibiotic resistance multiply resistant Vibrio cholerae, related Vibrios and

Enterobacteriaceae

A study on the incidence of diarrhoeal disease in domestic animals of Bangladesh and its relationship to that in human beings.

Influence of WCV on the immunogenicity of Bsubunit given by the oral oute.

child care (sociocultural aspects).Maternal and

Investigations on the mechanism of adhesion of Vibrio cholerae.

Socio-economic differentials of d;arrhoeal morhidity and mortality in selected villages of rural Bangladesh.

Colitis in patients with Caipylobacter, V.Paraiwemo-Clticus or shigellainfecto ar

Gastric emptying time in children with acute diarrhoea due to different etiologies.

Subsequent mortality of hospitalized children in

relation to their nutritional status.

Local immunity and natural termination of acute cholera.

Antenatal and postnatal care-sociocultural aspects.

Respiratory infections as complication to diarrhoea in hospital patients.

Growth rate and early introduction of weaning food.

The efficacy of ORS in correcting hypokalaemia dueto acute dehydrating diarrhoea in children under 5

years of age.

Pneumonia as a complication of diarrhoea: a re

trospective analysis.

The role of prostacycline in the development of

haemolytic-uremic syndrome in acute shigellosis

Further studies on the mechanisms of cholera and the host defensu mechanisms against cholera infection (Limited study).

Studies on the clinical manifestations and toxicities b"'Ae'omonas Hydrophila strains isolated from cases

of diarrhoea and their serological responses.

Studies on the pathogenic mechanisms of Campylobacter fetus ssp jejuni isolated in Bangladesh and their role in the aetiology of diarrhoea.

Isolation and Characterization of anaerobic bacterial flora from diarrhoeal patients.

Development of potential live oral vaccine strains of V/br/o cholerae.

Inter-village transmission of cholera in Matlab during the epidemic season.

ANNUAL REPORT 39

The programmes and activities of the ICDDR, B are explained to a group of participants at a train/ng course.

Study of standard ORS in treatment of dehydration of infants less than six months of age,

Measles antibody in serum and saliva.

Limited study of the dehydration status of Matlab patients (3,000) (1 September to 15 November, 1981)

Pilot study on socio-economic status and its associa-

tion with nutrition and morbidity

Intervention in environmental contamination with intestinal pathogens by using Oxfam Sanitary Unit in a periurban refugee camp.

Etiologic, clinical and epidemiological characteriza-tion of hospitalized rural diarrhoea cases.

Hydrogen breath test for estimation of lactose malabsorption in healthy volunteers and children with diarrhoea.

ANNUAL REPORT 40

Pilot project to follow up surveillance patients with shigella and other dysentery diseases.

Protein--losing enteropathy in post-measles diar-Fhoea.

Limited study of contraceptive prevalence in Matlab.

coeaThe effect of somatostatin on intestinal fluid loss in

Beliefs, attitudes and practices towards measles in rural Bangladesh.

FuLrther identification of colonization factors (CFA) in E. co/i and assays of antibodies of these factors aswell as of enterotoxins.

Studies on rotavirus serotypes in Bangladesh and Kenya.

The Hot and Cold Belief System and its Effect on Food Intake of Children During Normal. Acute and Recovery Stages of Diarrhoea.

Reproductive Endocrinology in Relation to Con-traceptive Safety in Bangladesh.

Study on Socio-Economic anc' Mortality Differentials.

Retrospective Study of Shigellosis at ICDDR,B Hospital.

Community Health Service Project, Matlab (The MCH Component).

Determination of the occurience of different fastidious enteric adenoviruses (FFAs) and an evaluation of their pathogen'c role in viral diarrhoea in Bangladesh.

Determinants of Areal Variation of Contraceptive Practices in Bangladesh.

ANNUAL REPORT 41

'Okpod

PROCEEDINCS OF THF COJNFEREN-d' ON EXP&IMENTAL CHOLE AVACC IINES

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DMWOM MEOSE

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Peoceedings of The 1$t ASlan' tonference on

INTERNATMAL

CENTRE FOP

DIARRHOEALDfSEASE MVH D SH

A ICDDR,B PUBLICATION SERIES.

Annual Report 1980. May 1981. 103 P.

Working Paper:

15 Becker S, Hiltabidle H. Comparison of measures of childbearing: patterns by age and parity in Matlab, Bangladesh. Mar 1981 .23 p.

16 Chowdhury Al, AzizKMA, Shaikh K. Demographic studies in rural Bangladesh, May 1969-April 1970. Api 1981. 21 p,

17 Chowdhury AI, Aziz KMA, Shaikh K. Demographic studies in rural Bangladesh. May 1970-April 1971. Apr 1981. 23 p.

181slam MS, Becker S. Interrelationships among certain sc, oeconomic variables in a rural popula-tion of Bangladesh. May 1981. 16 p.

19 Molla A, Molla AM, Sarker SA, Khatoon M, Rahaman MM. Effects of diarrhoea on absorption

and afterof macronutrients during acute stage recovery. Jun 1981. . p.

20 Molla AM, Molla A, Sarker SA, Rahaman MM. Intake of nutrient during and after recovery from diarrhoea in children. Jun 1981.22 p.

21 Khan MU, Shahidullah M. Epidemiologic pattern of diarrhoea caused by non agglutinating virio (NAG) and EF-6 organisms in Dacca Jun 1981n 21natural

22 Wahed MA, Rahaman MM. Gilman RH, Greenough WB, II11Sarker SA Protein-losing enteropathy in diarrhoea: application ol . antilrypsin assay. Aug 1981 . 12p.

23 Phillips JF, Stinson W, Bhatia S, Rahman M. Chakraborty J The demographic impact of two contraceptive service projects in Matlab thana of Bangladesh: a compendium of findings for the 1975-1980 period Oct 1981. 82 p.

24 Becker S, Chowdhuiy MK The 1978 sex ratio at birth (appendix to Demographic surveillance system-Matlab, 1978). Nov 1981. 14 p.

Scientific Report:

41 Rahrnan M, Chen LC, Chakraborty J, Yunus M,

Chowdhury Al, Sarder AM, Bhatia S, Curlin GT. Reduction of neonatal mortality by immunization of non-preynait women and women during pregnancy with alluminum-adsorbed tetanus toxoid. Jan 1981. 18 p.

42 Sarder AM, Chen LC. Are there barefoot doctors

in Bangladesh: a survey of non-government rural health practitioners. Mar 1981. 21 p.

43 Rahman M, Chen LC, Chakraborty J, Yunus M, Faruque ASG, Chowdhury Al. Factors related to acceptance of tetanus toxoid immunization among pregnant women in a maternal-child health programme in rural Bangladesh. Jan 1981. 26 p.

44 Islam MS, Rahaman MM, Aziz KMS, Rahman M, Munshi MH, Patwari Y. Infant mortality in rural Bangladesh: an analysis of causes during neonatal and postneonatal period. Apr 1981. 14 p.

45 Khan MU. Role of water supply and sanitation in the incidence of cholera in refugee camps. May 1981. 14 p.

46 Chowdhury AKMA. Infant deaths, determinants and dilemmas (A cohort analysis for rural Bangla. desh). May 1981. 22 p

47 Chowdhury MK, Becker c, Razzaque A, Sarder AM, Shaikh K, Chen LC Demographic surveillance system Matlab. Volume 7. Vital vents and

migration 1978. May 1981. 71 p.

48 Chowdhury AKMA, Becker S. Determinants of

fertility study. Volume 1 Methods anddescriptive tables for the prospective study 19751978. May 1981. 46 p.

49 Khan MU. Efficacy of short course antibiotic prophylaxis in controlling cholera in contacts during epidemic. Jun 1981. 7 p.

50 Boyce JM, Hughes JM, Alim ARMA, Khan MU, Aziz KMA, WellsJG, Curlin GT. Patterns of shigella infection in families in rural Bangladesh. Aug 1981. 13 p.

Not listed in the earlier annual reports. ' Not listed earlier as published paper.

ANNUAL REPORT 43

51 Yunus M, Zimicki S,Baqui AH,Hossain KMB, Blaser MJ. Salmonella food poisoning in Bangla-desh. Aug 1981. 6 p.

52 Hughes JM, Boyce JM, Levine RJ, Khan MU, Aziz KMA, Huq MI, Curlin GT. Epidemiology of El Tor cholera in rural Bangladesh: importance of surface water in transmission. Sep 1981, 21 p

53 Yunus M, Rahman ASMM, Faruque ASG. Glass RI. A clinical trial of ampicillin versus trinietho-prim-sulfamethoxazole in the treatment ol shigella dysentery. Sep 1981. 11 p.

54 Khan MU, Shahidullah M, Ahmed WU, Barua DK, Begum T, Purification D, Rahman N. Inter-vention of shigello:is by hand washing. Dec 1981. 16 p.

Special Publication:

13 D'Souza S. A population laboratory for studying disease processes and mortality- the demograph:c surveillance systern. Matlab, Comilla, Bangladesh. Ju.i 1981.29 p.

14 Samadi AR, Aziz KMS eds. Proceedings of ICDDR,B Workshop: Medical Education on Diarrhoeal Diseases and Related Suhjects, Dacca, 15th-21st Nov 1980. Sep 1981 27 p.

15 Rahman S ed. Proceedings of the Conference on Experimental Chole;a Vaccines, Dacca, 6-8 Apr 1981. Nov 1981. 155 p.

16 Honda T,Akhtar 0, Glass RI. The Biken test for detection of enterotoxigpnic Escherichia cotI producing heat-labile exterotoxin (I T): a labora-tory manual. Nov 1981. 13 p.

Monograph:

2 Maloney C,Aziz KMA, Sarker PC. Beliefs and fertility in Bangladesh, Dec 1981. xv,366 p.

Thesis and Dissertation:

2 Rahman ASMM. Village practitioners of Bangla-desh: their characteristics and role in an oral rehydration programme. Feb 1981. 59 p.

3 Shahid NS. Complications of measles in rural Bangladesh (Long term complications in the under-two). Jun 1981. 38 p

Newsletter:

Glimpse: ICDDR,B Monthly Newsletter. V. 3, Nos. 1-12, Jan-Dec 1981.

ANNUAL REPORT 44

B ORIGINAL SCIENTIFIC PUBLISHED PAPERS.

Becker S. Seasonal patterns of fertility measures: theory and data ,JAm Statl Assoc 1981 Jun; 76(374):249-59

Becker S. Seasonality of deaths in Matlab, Bangladesh. IntJ Epidemiol 1981 Sep;10(3):271-80

Becker S. Seasonality of fertility in Matlab, Bangladesh. J Biosoc Sci 1981 Jari;13(1 ):97-105

Bliatia S,Faruque ASG, Chakraborty J. Changing profile of IUD users in family planning clinics in rural Bangladesh. J Biosoc Sci 1981 Ap.,13(2): 169-77

Bhatia STraditional childbhtsh practices: implications for a rural MCH program. Stud F-am Plano 1981 Feb;12(2):66-75

Black RE, Merson MH, Rowe B,Taylor PR, Alim ARMA, Gross RJ, Sack DA. Enterotoxigenic Escherichia coli diarrhoea: acquired immunity and transmission in an endemic area. Bull WHO1981;59(2):263-8

Black RE, Merson MH, Taylor PR, Yolken RH, Yunus M, Alim ARMA, Sack DA. Glucos3 vs

sucros; in oral rehydration solutions for infantsand young children with rotavirus-associated diarrhea. Pedatrics 1981 Jan;67(1):79-83

Black RE, Merson MH, Huq I, Alim ARMA, YunusM. Incidence and severity of rotavirus and Escherichia coh diarrhoea in rural Bangladesh; implications for vaccine development. Lancet 1981 Jan 17;1(8212):141-3

Briscoe J The political economy of energy in rural Bangladesh. Environmental Systems Program, Harvard University, Aug 1979. (Occasionalpaper)."

Brown KH, Gilman RH, Gaffar A, Alamgir SM, Strife JL, Kapikian AZ, Sack RB. Infections associated with severe protein-calori-i malnutrition in hospitalized in!ars and children. Nutr Res 1981;1:33- 46

Not listed in the earlier annual reports.t Not listed earlier as published paper.

Brown KH, Khatun M, Ahmed MG. Relationship of the xylose absorption status of children in Banqla desh to their absorption of macronutrients from local diets. Am J Cho Nutr 1981 ALg;34(8). 1540-7

Cain M, Khanam SR, Nahar S. Class, patriarchy, and women's work in Bangladesh. Pop Dcv Rev 1979 Sep,5(3):405-38"

Chen LC,HoLg E,Huffman SL A prospective study of the risk of diarrheal diseases according to the nutritional status of children. Am J Epideniol 1981 Aug;114(2):284-92

Chen LC,Huq E, D'Souza S. Sex bias in the family allocation of food and health care in rural Bangla-desh. Pop Dev Rev 1981 Mar:7(1):55-70

Claquin P. Private health care providers in rural Bangladesh. Soc Sci Med 1981 Apr;15Bk2): 153-7

Colwell RR,Seidler RJ,Kaper J,Joseph SW, Grie .; S,Lockman H, Manevai D,Bradford H,Roberts N, Remnimers E, Hug I, Htq A Occurrence oI VIho cholerae serotype 01 in Maryland arid Louisiana estuaries. Appi Environ Mcrobiol 1981 Fh, 41 (2):555-8

Ellerbrock TV. Oral replacement therapy in rural Bangladesh with home ingredients. Trop Doc

f1981 Oct;1 1(4):1 79 -83

Gilman RH, Spira W, Rabbani H, Ahmed W, Islam A, Rahaman MM. Single-dose ampicillin therapy for severe shigellosis in Bangladesh. J Infect Dis 1981 Feb;143(2):164-9

Glass RI, Cates W Jr, Nieburg P. Davis C, Russbach R, Northdurft H, Peel S,Turnbull R.Rapid assess-ment of health status and preventive-medicine needs of newly arrived Kampuchear. refugees. Sa Kaeo, Thaijand. Lancet 1980 Apr 19;1 (8173): 868-72"

Greenberg BL, rilman RH, Shapiro H, Gilman JB, Mondal G,Maksud M, Khatoon H. Chowdhury J Single dose piperazine therapy for Ascaris hmbricoides. an unsuccessful method of pronotlg growth. Am J Chin Nutr 1981 Nov;34(11):2508-16

Honda T, Akhtar Q,Glass RI, Kibriya AKMG. A simple assay to detect Escherichia coli producing heat labile enterotoxin; results of a field study of the Biken test in Bangladesh. Lancet 1981 Sep 19;2(8247):609-10

Hossain MM, Glass RI, Black RE. The prevalence of Ascaris, hookworm, and Trichuris in patients attending a rural diarrhoea treatment centre in Bangladesh. Southez'st Asian J Trop Med Pub Hith 1981 Dec;12(4)

Khan MU, Mosley WH, Chakraborty J, Sarder AM, Khan MR. The relationship of cholera to water source and use in rural Bangladesh. Int J Epidemiol 1981 Mar;10(1):23-25

Khan MU, Chakraborty J, Paul SR. Teeth as index to health and age in Bangladeshi children. Nutr Rep Internl 1981 Nov;24(5):963-71

Khan MU. Victims of childhood deaths. Indian J Pediatr 1981 Sep-Oct;48(394):575-80

Koster FT,Tung KSK, Gilman RH,AhrnedA, Rahaman MM,Williams RC Jr. Circulating immune complexes in bacillary and amebic dysentery. J Clin Lab Immunol 1981 May;5(3):153-7

Ma!oney C, A7iz KMA, Sarker PC Some beliefs concerning pregnancy and childbirth in Bangladesh. S Asian Anthrop 1981,2(2):61-70

Measham AR, Khan AR, Rosenhbrg MJ, Jabeen S, Akbar J,Banu H, Phillips JF. Thi demographic impact of tubectomy in Bangladesh. J Soc Stud (Dacca) 1981:(14):54-62

Molla AM, Hossain M, Islam R,Bardhan PK, Sarker SA. Hypoglycemia; a complication of diarrhea in childhood. Indian iediatr 1981 Mar;18k3): 181 -5

Molla AM, Rahman M, Sarker SA, Sack DA, Molla A. Stool electrolyte content and purging rates in diarrhea caused by rotavirus, enterotoxigenic E. coll, and V cholerae in children. J Pediatr 1981 May;98(5)835-8

Mutanda LN, Mansur MN, Rahman M, Molla AM. Antibiotic resistance of enterohactera isolated from hospitalized diarrhoeal patients. Indian J Med Res 1981 Jul;746-10

Mutanda LN, Kibriya AKMG, Mansur MN. Pattern of Shigella flexneri serotypes and drug-resistance in Dacca. Indian J Med Res 1981 Jan;3:8-12

"Not listed in the earler annual reports Collaborative work

ANNUAL REPORT 45

Phillips JF. A logit regression mothod for the multi-variate analysis of contraceptive attrition. In, Hermalin Al, Entwistle B eds. The role of surveys in the analysis of family planning programs. Liege, Ordina Editions, 1981:481-536 t

Potter RG, Phillips jF. Fitting and extrapolating con traceptive continuation curves by logit regres. sion. In: Heriialin Al, Entwistle B eds. The role of surveys in the analysis of family planning programs.Liege, Ordina Editions, 1981:453-480t

Rizvi N. Life cycle of Bangladeshi women and their role in the economy. S Asia Bull (University of California, Los Angeles) 1981 1:10-16

Sarder AM, Chen LC. Distribution and characteristics of non-government health practitioners in a rural area of Bangladesh. Soc Sci Med 1981; 1 5A(5):543-50

Snyder JD, Black RE, Baqui AH, Sarder AM. Preva-lonce of residual paral,/s's from paralytc ,ciornye-litis in a rural population of Bangladesh. Aro J Trop Med Hyg 1981 Mar;30(2):42630

Spira WM, Afimed OS. Gauze filtration and enrich, merit procedures for recovery of Vibrno chol'Tde from contaminated waters Appl Environ Microbiol 1981 Oct;42(4):730-3

Spire WM, HucMchulerA,A, A